Why do we evaluate 30‐day readmissions in general medicine? A historical perspective and contemporary data

James, Jonathan; Tan, Sheryn; Stretton, Brandon; Kovoor, Joshua G; Gupta, Aashray K.; Gluck, Samuel; Gilbert, Toby; Sharma, Yogesh; Bacchi, Stephen

doi:10.1111/imj.16115

Internal Medicine Journal

2023

DOI: 10.1111/imj.16115

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Why do we evaluate 30‐day readmissions in general medicine? A historical perspective and contemporary data

Jonathan James

Sheryn Tan

Brandon Stretton

et al.

Abstract: Reducing preventable readmissions is important to help manage current strains on healthcare systems. The metric of 30‐day readmissions is commonly cited in discussions regarding this topic. While such thresholds have contemporary funding implications, the rationale for individual cut‐off points is partially historical in nature. Through the examination of the basis for the analysis of 30‐day readmissions, greater insight into the possible benefits and limitations of such a metric may be obtained.

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2024

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Cited by 3 publications

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Association of health confidence with hospital length of stay and readmission

Brown,

Press,

Meltzer

2024

Journal of Hospital Medicine

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BackgroundLength of stay (LOS) is an important measure of hospital quality and may be impacted by patient participation. However, concepts of patient participation, like health confidence, have received little examination in hospitalized patients' LOS, especially in diverse populations.ObjectiveTo determine if the Health Confidence Score (HCS) is associated with hospital LOS and readmission in a socioeconomically diverse population.Designs, Settings and ParticipantsWe conducted a prospective cohort study in 2022 of adult general medicine patients at an academic hospital in Chicago, Illinois.InterventionNone.Main Outcome and MeasuresPatient‐reported responses to the HCS (scored 0 [lowest health confidence] to ‒12 [highest health confidence]), as well as demographic, socioeconomic, and clinical questions, were collected. Primary outcome was LOS and secondary outcomes were 30‐ and 90‐day readmission.ResultsAmong 2797 socioeconomically diverse patients who completed the survey (response rate 28.5%), there was an average HCS of 9.19 (SD 2.68, range 0–12). Using linear regression, patients with high HCS (HCS ≥ 9) had a 1.53‐day lower LOS (p < .01, 95% CI [‐2.11, ‐0.95]) than patients with a low HCS (HCS < 9). This association remained when examining individual HCS questions and controlling for covariates. In logistic regression, HCS was not significantly associated with readmission, but the question “I am involved in decisions about me” (adjusted model: OR 0.83; 95% CI [0.71, 0.96]; p = .01) was associated with 90‐day readmission.

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Association of health confidence with hospital length of stay and readmission

Brown,

Press,

Meltzer

2024

Journal of Hospital Medicine

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Characteristics and Readmission Risks Following Sepsis Discharges to Home

You,

Song,

Hsu

et al. 2024

Medical Care

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Objective: To examine the characteristics and risk factors associated with 30-day readmissions, including the impact of home health care (HHC), among older sepsis survivors transitioning from hospital to home. Research Design: Retrospective cohort study of the Medical Information Mart for Intensive Care (MIMIC)-IV data (2008–2019), using generalized estimating equations (GEE) models adjusting for patient sociodemographic and clinical characteristics. Subjects: Sepsis admission episodes with in-hospital stays, aged over 65, and discharged home with or without HHC were included. Measures: The outcome was all-cause hospital readmission within 30 days following sepsis hospitalization. Covariates, including the primary predictor (HHC vs. Home discharges), were collected during hospital stays. Results: Among 9115 sepsis admissions involving 6822 patients discharged home (66.8% HHC, 33.2% Home), HHC patients, compared with those discharged without services, were older, had more comorbidities, longer hospital stays, more prior hospitalizations, more intensive care unit admissions, and higher rates of septic shock diagnoses. Despite higher illness severity in the HHC discharges, both groups had high 30-day readmission rates (30.2% HHC, 25.2% Home). GEE analyses revealed 14% higher odds of 30-day readmission for HHC discharges after adjusting for risk factors (aOR: 1.14; 95% CI: 1.02–1.27; P=0.02). Conclusions: HHC discharges experienced higher 30-day readmission rates than those without, indicating the need for specialized care in HHC settings for sepsis survivors due to their complex health care needs. Attention to sepsis survivors, regardless of HHC receipt, is crucial given the high readmission rates in both groups. Further research is needed to optimize postacute care/interventions for older sepsis survivors.

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Predictive Modeling for Hospital Readmissions for Patients With Heart Disease: An Updated Review From 2012–2023

Zhang,

Cheng,

Fujiwara

et al. 2024

IEEE J. Biomed. Health Inform.

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Why do we evaluate 30‐day readmissions in general medicine? A historical perspective and contemporary data

Cited by 3 publications

References 27 publications

Association of health confidence with hospital length of stay and readmission

Association of health confidence with hospital length of stay and readmission

Characteristics and Readmission Risks Following Sepsis Discharges to Home

Predictive Modeling for Hospital Readmissions for Patients With Heart Disease: An Updated Review From 2012–2023

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